The Clinical Research Of Lung Protection Effect Of Lung Ultrasound-guided Recruitment Maneuver In Patients Undergoing Laparoscopic Cholecystectomy

Object:To explore the effect of using intraoperative lung ultrasound-guided recruitment maneuver on respiratory mechanics,hemodynamics,ultrasound imaging and postoperative pulmonary complications in patients undergoing laparoscopic cholecystectomy,and to find a reasonable strategy of recruitment maneuver during laparoscopic cholecystectomv.To provide a reference for the patients undergoing short-time laparoscopic surgery whether or not need to recruitment maneuver during the perioperative periodMethods:Ninety patients with laparoscopic cholecystectomy(LC).aged ≥ 18 years.of American Society of Anesthesiologists physical status grade Ⅰ-Ⅲ.were enrolled in our hospital from June 2018 to January 2019.All patients with body mass index(BMI)<40 kg/m2,have no severe pulmonary diseases(FVE1/FVC<30%)or thoracic deformed and neuromuscular diseases before surgery.The patients were randomly divided into three groups A group(volume controlled ventilation group,n=30).B group(volume controlled ventilation+recruitment maneuver group,n=30).C group(volume controlled ventilation+ultrasound-guided lung recruitment maneuver group,n=30).Volume-controlled ventilation(VCV)was performed using tidal volume(VT)6ml/kg(corrected body weight).PEEP 5 cmH2O.oxygen concentration of 0.6,suction ratio of 1:2,adjusting respiratory rate(RR)12-16 times/min.to obtain PETCO2 35-45cmH2O.When intraoperative hypertension or hypotension occurs,anesthesiologists are allowed to use vasoactive drugs to maintain hemodynamic stability Record each patients’ age,gender,weight,height,preoperative lung function,comorbldltles,pneumoperitoneum time,anesthesia time.surgery time.Group B,C were treated with recruitment maneuver and ultrasound-guided recruitment maneuver after intubation and after surgery.In perioperative period,all three groups were used the unified pre-operative medication,the anesthesia medication and the monitoring means.Perioperative anesthesia treatment were performed by the same group of anesthesiologists.Before induction of general anesthesia.Lung ultrasound scores(LUS)were recorded prior to patient anesthesia and recorded as abaseline LUS in the three groups.LUS、airway peak pressure、airway mean pressure、Static Lung Compliance、End of Carbon Dioxide Partial Pressure、Saturation of Pulse Oximetry、Mean Blood Pressure、Heart rate were recorded induction of general anesthesia 10min(T1),end of surgery(T2).tracheal extubation 30min(T3).Arterial blood gas analysis were tested at T1、T3,one milliliter blood samples were collected from the radial artery for recorded arterial partial pressure of oxygen and arterial partial pressure of carbon dioxide and calculated oxygenation index、alveolar arterial oxygen pressure difference、respiratory index、vd/vt.Postoperative clinical pulmonary infection score(CPIS)was used to record the pulmonary complications three days after surgery.Result:84 patients were included in the study.28 patients were included in group A,29 patients were included in group B and 27 patients were included in group C.The LUS of the three groups was significantly higher than that of the baseline(p<0.05).Compared with the group A.the LUS of the B、C group at T3 was lower(p<0.05).Compared with group B.the LUS of group C was lower than that of group B(p<0.05).Compared with T1,ppeak and pmean were significantly increased and CLst was significantly decreased(p<0.05)in group T1,and group A(36.68±7.55)was significantly higher than that in group B(53.69±5.77).and no significant difference was found between group A(36.68±7.55)and group B(53.69±5.77).In group C.52.66±6.18 lung compliance decreased significantly(p<0.05).Compared with group A,the MBP of group B was significantly lower than that of group A(p<0.05),and that of group B was significantly lower than that of group B(p<0.05).Compared with group A-PaO2、PaO2/FiO2 increase significantly in group B、C at T3.There was no significant difference in CPIS among the three groups(p>0.05).Conclusion:The pulmonary protective ventilation strategy with recruitment maneuver guided by lung ultrasound score(LUS)can decrease LUS,reduce airway peak pressure、airway mean pressure,increase static lung compliance,improve oxygenation in patients under laparoscopic cholecystectomy(<2 h).Ultrasound-guided lung recruitment maneuver has little effect on MBP,and blindly manipulation of RM has a harmful effect on hemodynamics of patients during operation,so needs to be carried out with caution.